Increasing Trainee Comfort with Nutrition.

OBJECTIVES: Nutrition counseling is necessary for the prevention and treatment of many chronic diseases. US survey data demonstrate that 61% of Internal Medicine (IM) residents receive little to no nutrition training. The objective of our study was to develop a curriculum to increase IM resident comfort and ability in conducting a nutritional assessment. METHODS: Categorical IM residents at a large academic medical center participated in a curriculum that included a lecture, a small-group discussion, and a skills exercise. Residents completed pre- and posttest surveys that evaluated their attitudes and comfort level with nutritional assessment. RESULTS: Eighty percent (84/105) of the residents participated in the curriculum and 48% (40/84) of them completed both pre- and postsession surveys. Residents who considered themselves moderately to extremely comfortable completing a nutritional assessment increased after the program (27.5% to 87.5%, P < 0.0001). The proportion of those who agreed or strongly agreed with the statement, "Nutritional counseling should be included in any routine appointment, just like diagnosis and treatment," increased from 62.50% to 80.00% (P = 0.012). The proportion of residents who considered lack of individual knowledge to be a barrier for nutrition counseling decreased from 65.79% to 42.11% (P = 0.0126). CONCLUSIONS: This curriculum was successful in increasing IM resident comfort with conducting a nutritional assessment.

Prognostic importance of modified geriatric nutritional risk index in oral cavity squamous cell carcinoma.

We probed the associations of preoperative modified geriatric nutritional risk index (mGNRI) values with prognosis in patients receiving surgery for oral cavity squamous cell carcinoma (OCSCC). This retrospective study analyzed the clinical data of 333 patients with OCSCC and undergoing surgery between 2008 and 2017. The preoperative mGNRI was calculated using the following formula: (14.89/C-reactive protein level) + 41.7 × (actual body weight/ideal body weight). We executed receiver operating characteristic curve analyses to derive the optimal mGNRI cutoff and employed Kaplan-Meier survival curves and Cox proportional hazard model to probe the associations of the mGNRI with overall survival (OS) and disease-free survival (DFS). The optimal mGNRI cutoff was derived to be 73.3. We noted the 5-year OS and DFS rates to be significantly higher in the high-mGNRI group than in the low-mGNRI group (both p < 0.001). A preoperative mGNRI below 73.3 was independently associated with unfavorable DFS and OS. A mGNRI-based nomogram was constructed to provide accurate OS predictions (concordance index, 0.781). Hence, preoperative mGNRI is a valuable and cost-effective prognostic biomarker in patients with OCSCC. Our nomogram facilitates the practical use of mGNRI and offers individualized predictions of OS.

Implementation of nutritional screening tools, nutritional assessment tools, and diagnostic criteria for malnutrition in convalescent rehabilitation wards: A nationwide survey.

BACKGROUND & AIMS: The utilization of recommended nutritional assessment measures in rehabilitation settings remains unclear. This study explored methods for identifying nutritional disorders using data from a nationwide survey conducted in convalescent rehabilitation wards. METHODS: This cross-sectional study analyzed the annual survey, including methods for identifying malnutrition, the risk of malnutrition, and overnutrition in Kaifukuki (convalescent) rehabilitation wards. Methods identifying malnutrition and risk of malnutrition were grouped into nutritional screening tools (NSTs), nutritional assessment tools (NATs), diagnostic criteria for malnutrition (DCM), and suboptimal methods (e.g., hypoalbuminemia). NSTs, NATs, and DCM were further categorized as "acceptable tools." The association between applying acceptable tools, hospital-based data (e.g., the number of beds), and ward-based data (e.g., assessor for nutritional status) was analyzed by logistic regression analysis with multiple imputations. RESULTS: In total, 885 hospitals with Kaifukuki rehabilitation wards responded to the survey, and 754 hospitals were included in the analysis. Registered dietitians assessed the nutritional status in 88% of the hospitals, whereas other professionals (e.g., nurses) evaluated the nutritional status in the remainder. NSTs (e.g., Mini Nutritional Assessment Short-Form), NATs (e.g., Subjective Global Assessment), DCM (e.g., Global Leadership Initiative on Malnutrition criteria), and suboptimal tools were used in 13.1%, 5.4%, 4.8%, and 74.6% of cases, respectively. Most hospitals used acceptable measures (e.g., body mass index) for overnutrition (91.2%). Multiple logistic regression analysis showed that assessments by registered dietitians (adjusted odds ratio[OR]: 2.20.95% confidence interval[CI]: 1.09-4.45) and hospital-owned food services, a proxy for limited clinical practice time of dietitians, were associated with a low likelihood of implementing acceptable measures (adjusted OR: 0.64, 95%CI: 0.43-0.97). CONCLUSIONS: Acceptable malnutrition measures, including the NSTs, NATs, and DCM, have not been widely applied in convalescent rehabilitation settings. The implementation of recommended tools for identifying malnutrition may be promoted when registered dietitians assess the patients' nutritional status.

Standardising and simplifying the Global Leadership Initiative on Malnutrition (GLIM) for its more general application.

BACKGROUND: Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass. AIMS: To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application. METHODS: (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies. RESULTS: (1) Participants' mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m2. In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST "1" were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST "2", 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST "1". (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST "1", by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST "2". CONCLUSIONS: Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; "gold standard" muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening.

The association between the 'at risk of developing undernutrition' category of the Short Nutritional Assessment Questionnaire 65+ and incident undernutrition in community-dwelling older adults.

BACKGROUND & AIMS: Screening tools like the Short Nutritional Assessment Questionnaire 65+ (SNAQ65+) have been developed for the early recognition of undernutrition in older adults. The SNAQ65+ screens for being undernourished (red), being 'at risk of developing undernutrition' (i.e. 'at risk', orange), or 'not at risk' (green). This study investigated whether community-dwelling older adults 'at risk' (orange) are more likely to develop undernutrition during a 3-year follow-up compared to those 'not at risk' (green). METHODS: Prospective data from a Longitudinal Aging Study were used. A total of 5461 observations, using multiple 3-year waves of participants aged ≥65 years with an orange or green baseline score were included. Logistic mixed models were used to assess the association with four indicators of incident undernutrition at 3-year follow-up: (1) red SNAQ65+ score (mid upper arm circumference (MUAC) < 25 cm and/or ≥4 kg self-reported unintended weight loss in 6 months); (2) MUAC <25 cm; (3) ≥4 kg self-reported unintended weight loss in 6 months; and (4) ≥10% objectively measured weight loss in 3 years. RESULTS: There were 53.1% female participants across waves, with a mean age of 74.2 (SD 6.1) years. Overall, 6.2% were 'at risk of developing undernutrition' (orange) at baseline. The incidence rates of undernutrition based on a red SNAQ65+ score, MUAC <25 cm, ≥4 kg self-reported unintended weight loss, and ≥10% measured weight loss were 10.4%, 2.9%, 6.4%, and 5.4%, respectively. Those 'at risk' (orange) had a higher odds ratio of incident undernutrition based on these four indicators than those 'not at risk' (green) (respective odds ratio's: 2.51 (95%CI 1.74-3.62); 2.16 (95%CI 1.11-4.20); 2.43 (95%CI 1.61-3.65); and 2.08 (95%CI 1.28-3.37)). CONCLUSION: Community-dwelling older adults screened to be 'at risk of developing undernutrition' (orange) with the SNAQ65+ have a more than two-fold higher odds ratio of developing undernutrition during a 3-year follow-up compared to those 'not at risk' (green).

Family caregivers' better nutritional status is associated with care recipients' better nutritional status.

BACKGROUND AND AIMS: A high proportion of older care recipients (CRs) face malnutrition and risk of malnutrition, affecting their functional abilities and posing challenges for caregiving. The aim of this study was to assess the risk for malnutrition among older CRs and the associated characteristics of both CRs and family caregivers (FCs) with nutritional status of CRs. METHODS: A cross-sectional study consisted of 120 CRs (≥65 years) and their 118 FCs (≥60 years). Nutritional status was assessed with the Mini Nutritional Assessment (MNA). RESULTS: The majority (63%) of the CRs had a risk of malnutrition (MNA score 17-23.5), and 7% had malnutrition (MNA score <17). The CRs had significantly lower MNA scores compared to their FCs (p < 0.001). The multivariate linear regression analysis showed that CRs' higher number of comorbidities (B = -0.37, p = 0.013) and higher P-hs-CRP (B = -0.10, p = 0.047) were associated with their decreased MNA scores. There was a positive association between CRs' hand grip strength (B = 0.11, p = 0.004) and FCs' MNA scores (B = 0.41, p = 0.004) with MNA scores of the CRs. CONCLUSION: Malnutrition and risk of malnutrition are common concerns in older CRs, especially those with a higher number of comorbidities and low-grade inflammation. Regular assessment of the nutritional status of both older CRs and FCs is justified, as FCs' better nutritional status is associated with better nutritional status of CR. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04003493.

Malnutrition and its determinants among older adults living in foster families in Guadeloupe (French West Indies). A cross-sectional study.

BACKGROUND: Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). METHODS: This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. RESULTS: Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers'rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult's rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. CONCLUSION: Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.

Comparison of nutritional risk indices (PNI, GNRI, mNUTRIC) and HALP score in predicting adverse clinical outcomes in older patients staying in an intensive care unit.

Malnutrition among critically ill older patients is a frequent problem in intensive care units (ICUs) and is associated with a higher risk of hospital/ICU length of stay (LOS) and mortality. The aim of this study was to evaluate malnutrition in older patients staying in an ICU using the hemoglobin, albumin, lymphocyte, platelet (HALP) score, modified nutrition risk in the critically Ill (mNUTRIC), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) and to determine the consistency between these tools and their association with clinical outcomes. This cross-sectional retrospective, observational, hospital-based study included 153 older patients (≥65 years of age), who were admitted to an internal medicine ICU. Sequential organ failure assessment (SOFA) scores and acute physiology and chronic health evaluation (APACHE) II were used to assess disease severity. Nutritional status was evaluated using mNUTRIC, GNRI, PNI, and HALP scores, and their association with ICU LOS and mortality was evaluated using ROC and regression analyses. The mortality rate of the patients was 43.1%. The risk of malnutrition was higher among non-survivors, with mNUTRIC scores showing a significant difference between the groups. The scores for all indices, except HALP, showed significant differences between the groups. APACHE-II, SOFA, and mNUTRIC were the strongest prognostic indices for ICU mortality, with mNUTRIC having the highest sensitivity and negative predictive value. The HALP score was not associated with ICU LOS or a significant prognostic factor for mortality. All indices except HALP were good indicators of clinical outcomes in the study population including older patients. Prospective studies in larger and specific patient populations are needed to draw a strict conclusion in this subject.

Performance of anthropometry-based and bio-electrical impedance-based muscle-mass indicators in the Global Leadership Initiative on Malnutrition criteria for predicting prognosis in patients with cancer.

BACKGROUND: Reduced muscle mass is a criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria; however, the choice of muscle-mass indicators within the GLIM criteria remains contentious. This study aimed to establish muscle-measurement-based GLIM criteria using data from bio-electrical impedance analysis (BIA) and anthropometric evaluations and evaluate their ability to predict overall survival (OS), short-term outcomes, and healthcare burden in patients with cancer. METHODS: This was a multicenter, prospective study that commenced in 2013 and enrolled participants from various clinical centers across China. We constructed GLIM criteria based on various muscle measurements, including fat-free mass index (FFMI), skeletal muscle index (SMI), calf circumference (CC), midarm circumference (MAC), midarm muscle circumference (MAMC), and midarm muscle area (MAMA). Survival was estimated using the Kaplan-Meier method and survival curves were compared using the log-rank test. Cox proportional hazards regression was used to assess the independent association between the GLIM criteria and OS. The discriminatory performance of different muscle-measurement-based GLIM criteria for mortality was evaluated using Harrell's concordance index (C-index). Logistic regression was used to evaluate the association of the GLIM criteria with short-term outcomes and healthcare burden. RESULTS: A total of 4769 patients were included in the analysis, of whom 1659 (34.8%) died during the study period. The Kaplan-Meier curves demonstrated that all muscle-measurement-based GLIM criteria significantly predicted survival in patients with cancer (all p < 0.001). The survival rate of malnourished patients was approximately 10% lower than that of non-malnourished patients. Cox proportional hazards regression showed that all the muscle-measurement-based GLIM could independently predict the OS of patients (all p < 0.001). The prognostic discrimination was as follows: MAMC (Chi-square: 79.61) > MAMA (Chi-square: 79.10) > MAC (Chi-square: 64.09) > FFMI (Chi-square: 62.33) > CC (Chi-square: 58.62) > ASMI (Chi-square: 57.29). In comparison to the FFMI-based GLIM criteria, the ASMI-based criteria (-0.002, 95% CI: -0.006 to 0.002, p = 0.334) and CC-based criteria (-0.003, 95% CI: -0.007 to 0.002, p = 0.227) did not exhibit a significant advantage. However, the MAC-based criteria (0.001, 95% CI: -0.003 to 0.004, p = 0.776), MAMA-based criteria (0.004, 95% CI: 0.000-0.007, p = 0.035), and MAMC-based criteria (0.005, 95% CI: 0.000-0.007, p = 0.030) outperformed the FFMI-based GLIM criteria. Logistic regression showed that muscle measurement-based GLIM criteria predicted short-term outcomes and length of hospital stay in patients with cancer. CONCLUSION: All muscle measurement-based GLIM criteria can effectively predict OS, short-term outcomes, and healthcare burden in patients with cancer. Anthropometric measurement-based GLIM criteria have potential for clinical application as an alternative to BIA-based measurement.

Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent's population.

BACKGROUND: Healthy eating habits at a young age are crucial to support growth and development and good general health. In this context, monitoring youth dietary intakes adequately with valid tools is important to develop efficient interventions and identify groups that are more at risk of inadequate intakes. This study aimed to assess the relative validity of the self-administered web-based 24-h dietary recall (R24W) for evaluating energy and nutrient intakes among active adolescents. METHODS: Participants were invited to complete one interviewer-administered 24-h dietary dietary recall and the R24W on up to three occasions within one month. A total of 272 French-speaking active adolescents aged 12 to 17 years from the province of Québec were invited to complete three R24W and one interview-administered 24-h recall. Student's t-test and correlations were conducted on sex-adjusted data. Percent differences, cross-classification (percentage of agreement), weighted Kappa and Bland-Altman plots were calculated. RESULTS: Mean (SD) energy intake from the R24W was 8.8% higher than from the interview-administered 24-h dietary recall (2558 kcal ± 1128 vs. 2444 kcal ± 998, p < 0.05). Significant differences in mean nutrient intake between the R24W and the interview-administered 24-h dietary recall ranged from 6.5% for % E from fat (p < 0.05) to 25.2% for saturated fat (p < 0.001), i.e., higher values with R24W. Sex-adjusted correlations were significant for all nutrients except for % E from proteins and thiamin (range: 0.24 to 0.52, p < 0.01). Cross-classification demonstrated that 36.6% of the participants were classified in the same fourth with both methods, 39.6% in the adjacent fourth, and 5.7% misclassified. Bland-Atman plots revealed proportional bias between the two methods for 7/25 nutrients. Completing at least two recalls with the R24W increased the precision of intake estimates. CONCLUSION: These data suggest that the R24W presents an acceptable relative validity compared to a standard interview-administered 24-h recall for estimating energy and most nutrients in a cohort of French-speaking adolescents from the province of Québec.

THE VALUE OF PREOPERATIVE PROGNOSTIC NUTRITIONAL INDEX IN GASTRIC CANCER AFTER CURATIVE RESECTION.

BACKGROUND: Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries. AIMS: To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients. METHODS: A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI. RESULTS: Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival. CONCLUSIONS: Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival.

Usefulness of the mini nutritional assessment short-form for evaluating nutritional status in patients with nontuberculous mycobacterial pulmonary disease: a prospective cross-sectional study.

BACKGROUND: Although the Mini Nutritional Assessment (MNA) is recognized as a useful tool for evaluating nutritional status in patients with various diseases, its applicability in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) remains undetermined. METHODS: We designed a prospective cross-sectional study to investigate whether the MNA Short-Form (MNA-SF) score can serve as a screening tool to assess the nutritional status of patients with NTM-PD. The MNA-SF was conducted upon patient enrollment, and correlation analyses were performed to compare MNA-SF scores with other nutritional measurements and disease severity. Multivariable logistic regression analyses were conducted to evaluate the association between MNA-SF scores and NTM-PD severity. RESULTS: The 194 patients with NTM-PD included in the analysis had a median age of 65.0 (59.0-69.0) years; 59.3% (n = 115) had low MNA-SF scores (< 12). The low MNA-SF group exhibited a lower body mass index (19.7 vs. 22.4 kg/m2, p < 0.001) and fat-free mass index (14.7 vs. 15.6 kg/m2, p < 0.001) than the normal MNA-SF group, as well as higher incidences of sarcopenia (20.0% vs. 6.3%, p = 0.008) and adipopenia (35.7% vs. 5.1%, p < 0.001). However, no significant differences in calorie and protein intakes were observed between the two groups. Low MNA-SF scores were associated with radiographic severity (adjusted odds ratio 2.72, 95% confidence interval 1.38-5.36) but not with forced vital capacity. CONCLUSIONS: The MNA-SF can effectively assess the nutritional status of patients with NTM-PD and can serve as an important clinical indicator in NTM-PD where treatment timing is determined by clinical judgment.

Investigation of accordance between nutritional assessment tools, and bio-electrical impedance-derived phase angle, with the global leadership initiative on malnutrition criteria in hemodialysis patients.

BACKGROUND: Malnutrition (MN) is a major health concern for patients with chronic kidney disease (CKD) who receive maintenance hemodialysis (MHD). These patients are particularly vulnerable to MN due to their compromised health status, which in turn increases the risk of morbidity and mortality. However, there is limited evidence on the use of reliable and effective tools for assessing MN in this population. This lack of sufficient data highlights the crucial need to assess MN within these patients, considering the significant mortality risk it poses. The first aim of this study was to compare the concurrent validity of three nutritional methods: the 7-point Subjective Global Assessment (7p-SGA), the Nutritional Risk Index (NRI), and the Nutritional Risk Screening from 2002 (NRS-2002) with the Global Leadership Initiative on Malnutrition (GLIM) criteria in MHD patients. The second aim was to investigate the advantage of the bio-electrical impedance-derived phase angle (PhA) in predicting MN. METHODS: one hundred sixty-eight outpatients (31% women) with a mean age of 56.9 ± 14.7 years and a median dialysis vintage of 48 months were included in this retrospective study. Nutritional scores, anthropometric measurements, biological markers, and body composition parameters were collected. RESULTS: According to GLIM standards, MN was identified in 80% of these patients. Using logistic regression (LR) analysis, all nutritional scores were significantly associated with GLIM criteria, with optimal sensitivity (94.4%) and specificity (85.7%) for 7p-SGA and NRI, respectively. For discriminating the nutritional risk, the GLIM criteria demonstrated a good agreement with 7p-SGA (Kappa concordance coefficient (κ) = 0.677, p-value<0.001) with a good level of accuracy (Area Under the Curve (AUC) = 0.841; 95% Confidence Interval (CI) = 0.705-0.977; p-value <0.001) when compared to the NRI and NRS-2002 (κ = 0.522, p-value<0.001 and κ = 0.411, p-value = 0.006, respectively). An excellent accuracy was found between PhA and the GLIM-defined MN, with an optimal cut-off value of 5.5° for males and 4.5° for females. The LR showed that arm circumference is the parameter that most influences the decrease of PhA (odds ratio 2.710, 95% CI = 1.597-4.597, p-value <0.001). CONCLUSION: Based on the results of the present study, 7p-SGA is the most sensitive score in identifying MN diagnosed by GLIM criteria. Nonetheless, NRI exhibits greater specificity. PhA is a valuable marker for MN in MHD patients.

Prognostic role of nutrition parameters on short- and long-term outcome in patients with primary resectable pancreatic ductal adenocarcinoma.

PURPOSE: Nutrition status of patients with pancreatic ductal adenocarcinoma (PDAC) has gained an increasing importance - especially in the preoperative setting. The aim of the present study was to evaluate different preoperative nutritional parameters including body composition parameters regarding their impact on short- and long-term outcome in patients with resectable PDAC. METHODS: This retrospective single center study included 162 patients, who underwent primary resection of PDAC from January 2003 to December 2018 at the University Hospital of Erlangen. The influence of different preoperative nutrition parameters as well as different CT-based body composition parameters on short- (major morbidity, postoperative pancreatic fistula (POPF) and longer hospital stay) as well as on long-term outcome (overall and disease-free survival) were tested using multiple regression analysis. RESULTS: Major morbidity and POPF occurred in 30% respectively 18%. Median length of hospital stay was 18 days. Median overall and disease free survival were 20.3 respectively 12.0 months. Multivariate analysis revealed among the different nutritional parameters following independent predictors: PMTH (psoas muscle thickness/height) for major morbidity (HR 2.1, p = 0.038), PMA (psoas muscle area) for a prolonged hospital stay >18 days (HR 7.3, p = 0.010) and NRS (nutritional risk score) for overall survival (HR 1.7, p = 0.043). CONCLUSION: In our cohort, nutritional parameters played a minor role in predicting short- and long-term outcome in patients with primary resectable PDAC, as there were only significant associations between selected psoas muscle parameters and short-term outcome parameters and the nutritional risk score (NRS) with the overall survival.

The Relationship Between Controlling Nutritional Assessment Score and Mortality in Patients with Chronic Coronary Syndrome: A Retrospective Study from Türkiye.

BACKGROUND: Controlling Nutritional Assessment (CONUT) score has been shown to have a higher predictive value compared to other nutritional scores in acute coronary syndrome. AIM: To determine the relationship between CONUT score and long-term mortality in patients with chronic coronary syndrome (CCS). METHODS: Between 2017 and 2020, 585 consecutive patients newly diagnosed and proven to have CCS by coronary angiography were included in the study. CONUT score and demographic and laboratory data of all patients were evaluated. The relationship between results and mortality was evaluated. RESULTS: The mean age of the patients was 64 years and 75% were male. Mortality was observed in 56 (9.6%) patients after a median follow-up period of 3.5 years. The median CONUT score was significantly higher in patients with mortality (P < 0.001). In multivariate regression analysis, the CONUT score was associated with mortality (Hazard ratio (HR): 1.63 (95% confidence interval (CI): 1.34-1.98 P < 0.001)). The area under curve (AUC) for long-term mortality estimation for the CONUT score was 0.75 (95% CI 0.67-0.82 P < 0.001). When the CONUT score value was accepted as 0.5, the sensitivity was 78% and the specificity was 60. CONCLUSION: CONUT score was found to be predictive of mortality in long-term follow-up of patients with CCS.

Association Between Geriatric Nutrition Risk Index and 90-Day Mortality in Older Adults with Chronic Obstructive Pulmonary Disease: a Retrospective Cohort Study.

Background: Malnutrition adversely affects prognosis in various medical conditions, but its implications in older adults with Chronic Obstructive Pulmonary Disease (COPD) in the ICU are underexplored. The geriatric nutritional risk index (GNRI) is a novel tool for assessing malnutrition risk. This study investigates the association between GNRI and 90-day mortality in this population. Methods: We selected older adults with COPD admitted to the ICU from Medical Information Mart for Intensive Care (MIMIC)-IV 2.2 database. A total of 666 patients were categorized into four groups based on their GNRI score: normal nutrition (>98), mild malnutrition (92-98), moderate malnutrition (82-91), and severe malnutrition (≤81) groups. We employed a restricted cubic spline (RCS) analysis to assess the presence of a curved relationship between them and to investigate any potential threshold saturation effect. Results: In multivariate Cox regression analyses, compared with individuals had normal nutrition (GNRI in Q4 >98), the adjusted HR values for GNRI in Q3 (92-98), Q2 (82-91), and Q1 (≤81) were 1.81 (95% CI: 1.27-2.58, p=0.001), 1.23 (95% CI: 0.84-1.79, p=0.296), 2.27 (95% CI: 1.57-3.29, p<0.001), respectively. The relationship between GNRI and 90-day mortality demonstrates an L-shaped curve (p=0.016), with an approximate inflection point at 101.5. Conclusion: These findings imply that GNRI is a useful prognostic tool in older adults with COPD in the ICU. An L-shaped relationship was observed between GNRI and 90-day mortality in these patients.

Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study.

BACKGROUND: Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda. METHODS: A comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1. RESULTS: A total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers' age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd - 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher. CONCLUSIONS: The comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health.

Impact of the prognostic nutritional index on renal replacement therapy-free survival and mortality in patients on continuous renal replacement therapy.

BACKGROUND: The survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status. OBJECTIVES: The prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT. METHODS: We analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality. RESULTS: Patients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status. CONCLUSIONS: PNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk.

BACKGROUND: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. METHODS: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. RESULTS: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. CONCLUSIONS: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.